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15-12-2009 | Diabetes | Article

Albuminuria warns of subclinical stroke in diabetes patients

Abstract

Free abstract

MedWire News: Patients with Type 2 diabetes who have albuminuria are likely to have prevalent silent cerebral infarction, Japanese research shows.

Decreased kidney function as reflected by estimated glomerular filtration rate (eGFR) was not independently linked to cerebral infarction, however.

The study, conducted by Tetsuya Babazono and team from Tokyo Women’s Medical University School of Medicine, involved 786 patients with Type 2 diabetes who underwent cranial magnetic resonance imaging to screen for silent cerebral infarction.

The team detected subclinical infarcts in 52.8% of patients and classified 53.9%, 26.5%, and 19.6% as having normoalbuminuria, microalbuminuria, and clinical albuminuria (first morning urinary albumin-to-creatinine ratio (ACR) ≥30 mg/g), respectively, while 32.9% had reduced kidney function (eGFR <60 ml/min/1.73 m2).

Compared with patients without infarcts, those with infarcts had a longer duration of diabetes and were more often receiving diabetic medication. They also had more stroke risk factors, including older age, higher blood pressure, atrial fibrillation, diabetic retinopathy, and cardiovascular disease.

The likelihood of patients having silent cerebral infarction rose in line with increasing ACR and decreasing eGFR. But the relationship of infarction with eGFR lost statistical significance after accounting for vascular risk factors, whereas that with ACR remained significant. The link between ACR and cerebral infarction also remained consistent after excluding patients with previous clinical cerebrovascular disease.

ACR predicted silent cerebral infarction regardless of eGFR, but eGFR was only associated with infarction in patients with clinical albuminuria.

“Albuminuria and cardiovascular disease share numerous risk factors that may explain this relationship, including oxidative stress, inflammation, endothelial dysfunction, obesity, thrombotic state, hypertension, and dyslipidemia,” the researchers write in the journal Diabetic Medicine.

“In addition, similarities between the hemodynamic and anatomical aspects of renal and cerebral small vessel disease may help to explain the relationship between albuminuria and silent cerebral infarction in Type 2 diabetes mellitus patients in this study.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

By Eleanor McDermid